Eccentric loading of biceps tendon effective for biceps tendinosis, provide progression program
· 2014 systematic review conclusion was little clinical or mechanical evidence to support eccentric component alone
· Many well conducted studies of various comparison groups are lacking, however up to 45% of people are not responsive to eccentrics
· Stevens 2014 Alfredson protocol for Achilles tendonopathy180 eccentrics per day regardless of pain
· Only conducted on athletic population
· Another study was athletic vs. sedentary population, Alfredson protocol for athlete and “exercise within tolerance” for sedentary over 6 weeks
· Mean volume 112 “tolerance” and 166 Alfredson
· Tolerance had linear improvement, Alfredson decreased within first 2 weeks, then evened out at week 6
· HSR (Isotonic) vs. Eccentric Beyer 2015 for Achilles Tendonopathy
· 12 week study with 1 year follow up, 3s concentric and eccentric
· Total loading time 63 min Alfredson, 41 min HSR
· No difference in results
· Difference was in compliance 78% Alfredson and 92% HSR
· Patient satisfaction 76% Alfredson and 96% HSR
· Eccentrics are widely used however movement of entire muscle-tendon unit at a given load and range of motion have little to no difference of effect on the tendon
· For compliance and overall results I would perform isometrics in place of pure eccentric exercises for rehabilitation.
· During isotonic loading both concentric and eccentric loading is utilized
Phases of Progression
1) Isometric loading
2) Isotonic loading
3) Energy Storage loading
4) Return to sport
Review morphology of acromion, how common are they and how do they contribute to impingement
· Described by Bigliani as type I, type II or type III
· Type I is flat
· Type II is curved
· Type III hooked
· A person with a type II or type III acromion would be at a higher risk of impingement due to the narrowing of the acromiohumeral gap and bursal space
· Advancing age people tend to develop a spur on the front and side of the acromion
· This further reduces the subacromial space increasing the risk of impingement
· Incidence of the spur increases with age due to tension from the coraohumeral ligament
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Dr. Mike Hadbavny
Chiropractor, Sports Sciences Resident RCCSS(C)
If you are interested in learning more about how chiropractic care can be effective for your particular condition or health goals, contact Dr. Mike Hadbavny at 250-881-7881 today to make an appointment and discover the many benefits of seeing a chiropractor in Victoria BC. Contact us today.
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